Healthcare Provider Details

I. General information

NPI: 1386322188
Provider Name (Legal Business Name): ALI HUSSEIN AWAD M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALI AWAD

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 03/11/2024
Certification Date: 07/11/2023
Deactivation Date: 02/16/2024
Reactivation Date: 03/11/2024

III. Provider practice location address

6500 NEWBERRY ROAD
GAINESVILLE FL
32605
US

IV. Provider business mailing address

1500 NW 4TH AVENUE APT 213
GAINESVILLE FL
32603
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-5173
  • Fax:
Mailing address:
  • Phone: 313-316-3107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTRN38616
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: